The General Medical Council, regulator of the UK’s doctors, has been getting a bit of a drubbing recently in terms of how it treats doctors who are not well. A hard-hitting Civitas report held the organisation to account over its own performance. The report was about regulation generally, but it touches on issues relevant to doctors’ health. A study published in the British Medical Journal followed and a commentary in BMJ Careers did not let up the pressure. I’m planning to take a look at those documents in a future blog.
So what’s the deal? Is the GMC prejudiced in the way it treats doctors with addictions and/or mental health problems? Does the regulator need regulating?
The Civitas Report
Civitas is an independent think tank looking at civil society. The report’s authors – two doctors and a lawyer – have impressive credentials and offer credible perspectives. They provocatively title their paper The GMC: fit to practise? The authors use a variety of data sources and doctors’ experiences to argue their point that paradoxically the more control a regulator exerts over healthcare the greater the risk to patients.
- The GMC remains funded by mandatory levies on doctors. Annual subscriptions increased 20-fold in real terms from 1970-2010
- The number of complaints made to the GMC about doctors rose 8-fold between 1992-2012
- The number of public hearings increased 5-fold between 1992-2012
- The number of erasures from the medical register increased 12-fold between 1992-2012. For every erasure in 2012, there were 5 suspensions from practice. Three quarters of those were prior to any public hearing
Concerns for doctors’ health
So either the medical profession is getting very much worse (something the GMC agrees there is no evidence to support) or the way the regulator is dealing with problems has changed. Concern after concern is raised in the Civitas report. And the effect on doctors’ mental health while they are being investigated?
In 2013, attention was drawn to suicides associated with GMC proceedings. The regulator revealed, in response to a Freedom of Information request from the campaign group doctors4justice, that 96 doctors had died since 2004 whilst subject to investigation.
And Dr Claire Gerada, former Chair of the Royal College of GPs has her own view:
The director of the London-based Practitioner Health Programme, which has supported many doctors going through GMC investigations, has recently commented that the GMC is “traumatising” doctors and may be harming patients.
The authors accept that good medical care and patient safety is paramount, but they have some challenges for the GMC:
- The GMC should publicly acknowledge their duty of care to doctors alongside that due to patients.
- NHS employers must acknowledge the effect on their staff of adverse events and complaints (including those that they have instigated themselves) and have regard to their duty of care to staff. They must be required to put in place measures to ensure proper support for doctors (and other professionals) subject to complaints, and they should be performance-managed on this
Why on earth should doctors have to face a harsh regulatory approach when they develop their own health problems? Might we actually benefit from moving towards Physicians’ Health Programmes similar to those in the USA? These have great outcomes for addicted doctors. Where doctors comply with treatment the regulator (Boards in the US) do not necessarily need to be involved. We have our own version of this in the London area. How about rolling it out?